<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header"></head>
<body class="gray-bg">
	<div class="wrapper wrapper-content ">
		<div class="row">
			<div class="col-sm-12">
				<div class="ibox float-e-margins">
					<div class="ibox-content">
						<form class="form-horizontal m-t" id="signupForm">
							<div class="form-group">	
								<label class="col-sm-3 control-label">承保险别：</label>
								<div class="col-sm-8">
									<input id="insurancesort" name="insurancesort" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">险别id：</label>
								<div class="col-sm-8">
									<input id="sortid" name="sortid" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">保险总额：</label>
								<div class="col-sm-8">
									<input id="amount" name="amount" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">保险费用：</label>
								<div class="col-sm-8">
									<input id="charge" name="charge" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">投保开始时间：</label>
								<div class="col-sm-8">
									<input id="starttime" name="starttime" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">投保到期时间：</label>
								<div class="col-sm-8">
									<input id="endtime" name="endtime" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">保险公司名字：</label>
								<div class="col-sm-8">
									<input id="insurcompany" name="insurcompany" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">保险公司主键：</label>
								<div class="col-sm-8">
									<input id="companyid" name="companyid" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">理赔日期：</label>
								<div class="col-sm-8">
									<input id="settlementdate" name="settlementdate" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">理赔金额：</label>
								<div class="col-sm-8">
									<input id="settleamount" name="settleamount" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">保险业务员：</label>
								<div class="col-sm-8">
									<input id="insursalesman" name="insursalesman" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">经办人：</label>
								<div class="col-sm-8">
									<input id="agent" name="agent" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">经办人id：</label>
								<div class="col-sm-8">
									<input id="agentid" name="agentid" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">设备id：</label>
								<div class="col-sm-8">
									<input id="deviceid" name="deviceid" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-3 control-label">是否已出险  1是  0否：</label>
								<div class="col-sm-8">
									<input id="lossoccurred" name="lossoccurred" class="form-control" type="text">
								</div>
							</div>
																					<div class="form-group">
								<div class="col-sm-8 col-sm-offset-3">
									<button type="submit" class="btn btn-primary">提交</button>
								</div>
							</div>
						</form>
					</div>
				</div>
			</div>
	</div>
	</div>
	<div th:include="include::footer"></div>
	<script type="text/javascript" src="/js/appjs/custom/deviceInsurance/add.js">
	</script>
</body>
</html>
